Early Signs Of Erectile Dysfunction

Ever wondered if you might be on your way to developing erectile dysfunction but you’re just not sure? Read on. This article might just help to point you in the right direction. Ready for a short quiz? It won’t give you a diagnosis but it can give you an indication as to whether you have a problem. It’s called the Sexual Health Inventory for Men. There are 5 questions to answer and each question has five possible responses. You should choose the number that best describes
your own situation and select only one answer for each question.


Over the last six months:

How do you rate your confidence that you could keep an erection?

1 – Very low

2 – Low

3 – Moderate

4 – High

5 – Very high


When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?

1 – Almost never or never

2 – A few times (much less than half the time)

3 – Sometimes (about half the time)

4 – Most times (more than half the time)

5 – Almost always or always


During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

1 – Almost never or never

2 – A few times (much less than half the time)

3 – Sometimes (about half the time)

4 – Most times (more than half the time)

5 – Almost always or always


During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

1 – Extremely difficult

2 – Very difficult

3 – Difficult

4 – Slightly difficult

5 – Not difficult


When you attempted sexual intercourse, how often was it satisfactory for you?

1 – Almost never or never

2 – A few times (much less than half the time

3 – Sometimes (about half the time)

4 – Most times(more than half the time)

5 – Almost always or always


That’s it. Now it’s time to do some maths. Add together the numbers corresponding to the answers to all the questions. Although these scores can’t give you a definitive diagnosis, it can give you an idea of whether you might have a problem.

Your scores and what they might mean:

22-25: No significant erectile dysfunction
17-21: Mild erectile dysfunction
12-16: Mild to moderate erectile dysfunction
8-11: Moderate erectile dysfunction
5-7: Severe erectile dysfunction


If you have a score of 21 or less, it is likely that you have an issue with erectile dysfunction. What if you scored between 17-21? Well, it could be a signal that you are on your way to developing a problem. Erectile dysfunction could actually be an early warning sign for some bigger medical
issues. That is because it is linked to many other health conditions. There is evidence to say that erectile dysfunction could be an early manifestation of coronary artery and peripheral vascular disease preceding its onset by 8-10 years. Perhaps in the past, there may have been attitudes that made light of this condition but we can afford complacency no more. Broadly speaking, there are eight categories are linked to developing erectile dysfunction.


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Vascular disease

(diseases involving blood vessels) is the most common cause of erectile dysfunction. Penile arteries (blood vessels in the penis) have a smaller diameter than the major arteries of the heart so the earliest sign that you might get indicating you have a problem with your
cardiovascular system might actually be erectile dysfunction. Cardiovascular diseases that are linked to erectile dysfunction include high blood pressure and high cholesterol. Diabetes is also linked.

Neurogenic disease

(diseases involving the nervous system) such as multiple sclerosis, Parkinson’s disease, diseases or trauma of the spinal cord, stroke, tumours of the central nervous system.
Complications caused by previous surgeries or a history of trauma. Anatomical or structural issues that cause a physical problem including penile cancer or tumours of the genitals.

Hormonal problems

for example hypogonadism, overactive or underactive thyroid, Cushing’s disease.

Drug-induced erectile dysfunction.

There are many different types of medicines that are associated with erectile dysfunction as a side effect. The list is extensive and includes some medicines used to treat high blood pressure, depression, and mental health disorders. This list could get very long. If you suspect or want to find out if any of your medicines could be linked to erectile dysfunction, speak to a doctor or pharmacist. They may be able to suggest alternative treatment options. Recreational drugs such as alcohol, heroin, cocaine, marijuana, anabolic steroids can also cause erectile dysfunction.

Long-term disorders

such as kidney or liver problems, open angle glaucoma, inflammatory bowel disease.

Psychological causes

This could take many different forms. It could be related to anxiety or depression, a general lack of arousal, issues with your partner, performance related issues or distress. Our body is an interconnected series of systems, so whilst it is useful to know the many reasons that could be contributing to erectile dysfunction, in reality, there could be a mixture of reasons as to why it is happening. That is why it is important to get the right kind of help early on. More importantly, it could be your body telling you that there may be other problems developing.

Erectile dysfunction has been linked to some lifestyle choices. Here are some tips that might help to decrease your risk factors for developing erectile dysfunction and be of benefit to your general health.

  1. Get moving! Exercise is good for the circulatory system. It helps to keep blood flowing in the body and good circulation is what is needed for erections. The arteries in the penis are very small and often erectile dysfunction is one of the first signs that damage to the blood vessels is occurring in the body. If the blood flow is inadequate, erectile problems can occur. These could result in weak erections or simply no erection at all. Conditions such as high blood pressure, high cholesterol, diabetes all increase your risk of damage to the arteries. Regular exercise keeps the blood pumping but it can also have other beneficial effects such as helping to maintain a healthy weight, reducing your risks for developing heart disease and diabetes. It can also help to increase testosterone levels and reduce depression and anxiety.
  2. Keep your blood pressure in the healthy zone. Blood pressure is measured in millimetres of mercury (mmHg). When you get a blood pressure reading, you will see it expressed as 2 figures: systolic pressure: the pressure exerted when your heart pushes blood out and diastolic pressure: the pressure exerted when your heart rests between beats. As a general guide, a healthy blood pressure reading is considered to be between 90/60mmHG and 120/80mmHg. High blood pressure is considered to be 140/90 mmHg or above and low blood pressure is considered to be 90/60 mmHg or lower. High blood pressure can result in the arteries getting damaged. This is caused by the high pressure exerted by blood pushing against the artery walls. The damaged lining then become surfaces for plaque that might be present in the bloodstream to accumulate and result in the arteries becoming hardened. If this happens to the arteries in the penis, then it would result in insufficient blood flow to achieve an erection.
  3. Get some sunshine. When we are outdoors, our bodies create Vitamin D when our skin is exposed to direct sunlight. In the UK, most people would be able to get all the Vitamin D they need from sunlight from about late March to the end of September. Most people can make enough Vitamin D simply from being out in the sun with their forearms, hands and lower legs uncovered for short periods. Some foods such as red meat, eggs as well as oily fish such as salmon, mackerel and sardines do contain Vitamin D. In the UK, winter sunlight (October to early March) doesn’t contain enough ultraviolet B so we have to rely on our food sources and supplements to get enough Vitamin D. Sunbeds are not a recommended way of getting Vitamin D. It is not known exactly why and how vitamin D deficiency is linked to erectile dysfunction but a study published in 2016, looked at over 3000 men in America and showed that vitamin D deficiency was associated with a higher rate of erectile dysfunction.
  4. Quit smoking. Smoking can cause damage to the lining or your blood vessels or lead to a hardening of your arteries. It can also decrease nitric oxide which is a chemical that is crucial in erections. Smoking can also affect the smooth muscle tissue which can interfere with the mechanics of achieving an erection.
  5. Limit your sugar intake. Too much sugar in your diet increases your risk of developing diabetes. According to the International Society for Sexual Medicine, men with diabetes are about four times more likely to go on to develop erectile dysfunction compared to non-diabetic men and are also more likely to start having problems with erections at earlier ages. A diet that is high in sugar and refined carbohydrates can also contribute to the development of metabolic syndrome. This term is used to define a group of conditions that put you at risk of developing coronary heart disease, stroke and diabetes. Current advice from the NHS suggests that adults should consume no more than 7 teaspoons added sugar a day- 30g. That’s less than what is in a single can of some soft drinks!
  6. Adopt a Mediterranean diet. This is a diet that is rich in fish, fruits, vegetables, nuts, legumes, whole grains and monounsaturated fats (for example from olive oil). Research published in 2018 considered the association between diet and male sexual health. The research considered data spanning from 1977 to 2017 and compared four different types of diets: western, Mediterranean, palaeolithic and vegetarian and vegan diets. The work suggests that evidence exists to support the lessening of erectile dysfunction in men adhering to the Mediterranean diet.
  7. Look after your oral health. There is some evidence to suggest that men who have been diagnosed with gum disease have a higher rate of erectile dysfunction. It is not yet fully known why this link exists although it has been suggested that severe gum disease can decrease nitric oxide; an important chemical messenger involved in erections. Consistent brushing, flossing and dental checkups are the best way to keep gum disease at bay.

Achieving an erection is a complex phenomenon and requires delicate and coordinated interplay between the nervous, vascular and smooth muscle systems in your body. There is a myriad of reasons as to why you might be experiencing erectile dysfunction. The best way of finding out what could be causing this problem for you is to get medical advice. This can then help you take some steps that could reverse your risk factors to prevent the situation from getting worse or treat the problem.


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  1. British Association of Urological Surgeons (online) Available at https://www.baus.org.uk/ professionals/sections/erectile_dysfunction.aspx
  2. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. 1994. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 151(1):54-61
  3. Randrup E, Baum N, Feibus A. Erectile dysfunction and cardiovascular disease. 2015 Postgraduate Medicine 127 (2)
  4. European Association of Urology (2017) Guidelines on male sexual dysfunction. European Association of Urology. [Free Full-text]
  5. Farag YMK, Guallar E, Zhao D, Kalyani RR, Blaha MJ, Feldman DI, Martin SS, Lutsey PL,
  6. Billups KL, Michos ED. Vitamin D deficiency is independently associated with a greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004. Atherosclerosis. 2016 Sep;252:61-67
  7. Sergio Varela Kellesarian, DDS, Tammy Varela Kellesarian, DDS, MPH, Vanessa Ros Malignaggi, DDS, Mansour Al-Askar, DDS, Alexis Ghanem, DDS, Hans Malmstrom, DDS, and Fawad Javed, DDS, Ph. 2018. D Association Between Periodontal Disease and Erectile Dysfunction: A Systematic Review. Am J Mens Health. 2018 Mar; 12(2): 338–346.
  8. International Society for Sexual Medicine Available at https://www.issm.info
  9. NHS (2018)How to get vitamin D from sunlight Available at https://www.nhs.uk/live-well/healthybody/how-to-get-vitamin-d-from-sunlight/
  10. NHS (2016) What is blood pressure? Available at: https://www.nhs.uk/common-health-questions/lifestyle/what-is-blood-pressure/

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